HHS
What is the IV fluid that is an immediate treatment for HHS
A. LR
B. 0.9% normal saline
C. Dextrose 10%
D. Hypertonic 0.33% saline
B. 0.9% normal saline
When preparing the client with hyperosmolar hyperglycemic nonketotic syndrome (HHS) for discharge and home management, which significant teaching information should be shared with the client?
A. Reduce fluid intake
B. Monitor blood glucose monthly
C. Increase fluid intake
D. Monitor heart rate
Answer: Increase fluid intake
Which medications control hyperglycemia? (Select all that apply)
A. Metformin
B. Regular insulin
C. Intermediate insulin
D. Lantus insulin
E. Sulfonylureas
F. All of them
Answer: F (All of them)
See TABLE 53.5 Drug Therapy
What is the pathophysiology of HHS?
A. Develops slowly over days to weeks
B. Most common in type 1 diabetes
C. Absence of dehydration
D. Results in low blood glucose
Answer A: Develops slowly over days to weeks
What are some signs and symptoms of DKA?
A. Hypoglycemia
B. Alkalosis
C. Kussmaul breathing
D. Glasgow coma scale of 12
Answer: Kussmaul breathing
What does HHS involve?
A. Older adults are more confused with HHNS
B. Have a malfunction of the heat-regulating mechanism in the brain
C. Mostly occur in any type of diabetes
D. Extreme hyperglycemia without DKA
Answer: Extreme hyperglycemia without DKA
A client with type 2 diabetes has been prescribed a daily dose of metformin, the nurse should prioritize which of the following labs?
A. Serum osmolality
B. BUN levels
C. Electrolytes
D. CRP
Answer: B (BUN levels)
Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the client’s kidney function.
Why is it critical to slowly administer IV sodium replacement?
A. The intracellular fluid becomes hypertonic very fast.
B. Severe hyponatremia will occur
C. Intake must match output
D. Causes permanent brain damage
Answer: D (Causes permanent brain damage)
Which nursing intervention would the nurse implement for a client with SIADH?
A. Review the nutritional requirements
B. Obtain a daily weight on the client.
C. Implement fall precautions
D. Fluid restriction of 800-1000 mL/day
Answer: Fluid restriction of 800-1000 mL/day
What is the difference between DKA and HHNS?
A. Muscle strength and muscle mass increase with HHS.
B. Potassium deficits are milder in HHS
C. Onset of DKA is gradual
D. Middle adulthood men have a greater problem with DKA
Answer B. Potassium deficits are milder in HHS
Which of the following findings should the nurse expect for the client with complications due to HHS?
A. Cerebral edema and neurologic deficits
B. Extreme ketones similar to DKA
C. Rapid onset of metabolic acidosis
D. Mostly occur in any type of diabetes
Answer A: Cerebral edema and neurologic deficits
For diabetic ketoacidosis (DKA), which electrolyte imbalance must be monitored as a priority?
A. Sodium
B. Potassium
C. Chloride
D. Magnesium
B. Potassium
There is a risk of serum potassium dilution, causing hypokalemia. Potassium replacement must begin once potassium levels drop
How does long term insulin work?
A. Need multiple doses
B. Give before meals
C. Give after meals
D. Released for at least 24 hours
Answer: D (Released for at least 24 hours)
Which lab level is a critical component of HHS?
A. Blood glucose: usually >600 mg/dL
B. Serum osmolality: less than 120 mOsm/kg
C. Increased ketone level
D. Bicarbonate less than 5
Answer: A (Blood glucose: usually >600 mg/dL)
Which nursing intervention is essential during DKA treatment to monitor fluid overload?
A. Potassium balance
B. Sodium balance
C. Strict intake and output measurement
D. Administering rapid IV fluids
Answer C: Strict intake and output measurement
HHS pathophysiology involves which of the following?
A. Electrolyte imbalances
B. Diuresis due to diuretics
C. Fluid volume gain
D. Severe hypoglycemia
Answer: Electrolyte imbalances
Which diagnostic test would a nurse anticipate for neuropathy?
A. Glucose Tolerance Test
B. Nerve conduction test
C. WBC
D. Chest X-ray
B. Nerve conduction test
Which signs and symptoms should the nurse teach related to insulin therapy?
A. Dizziness, rapid heartbeat, low blood pressure
B. Persistent headache or changes in mental status
C. Nausea or vomiting
D. Sudden weight loss or gain
E. Confusion, fatigue, or muscle cramps
F. All of them
F. All of them
What causes SIADH?
A. Kidney failure
B. Loss of appetite
C. Excessive ADH secretion
D. Increased osmolality
Answer: Excessive ADH secretion
What are the nursing actions/interventions for DKA? (Select all that apply)
A. Vital signs (frequent—including respiratory rate and pattern)
B. Blood glucose and serum ketone levels frequently
C. Fluid status: intake/output, signs of dehydration or fluid overload
D. Electrolyte balance (especially potassium) and cardiac rhythm (telemetry)
E. Neurologic status (monitor for changes in consciousness)
F. ABGs
Answer: All of them
Vital signs (frequent—including respiratory rate and pattern)
Blood glucose and serum ketone levels frequently
Fluid status: intake/output, signs of dehydration or fluid overload
Electrolyte balance (especially potassium) and cardiac rhythm (telemetry)
Neurologic status (monitor for changes in consciousness)
ABGs
Review TABLE 53.19: Interprofessional Care for DKA and HHS
What is one manifestation of HHS?
A. Altered mental status
B. Glucose level less than 60 mg/dL
C. Hypertension
D. High levels of ketones
Answer: Altered mental status
What is the goal of sodium replacement for SIADH?
A. Increase Na by no more than 8-12 mEq/L in 24 hours
B. Increase Na rapidly in 8-12 hours
C. Decrease Na by 8-12 mEq/L in 24 hours
D. To get an accurate intake and output
Answer: A (Increase Na by no more than 8-12 mEq/L in 24 hours)
Why is normal saline (0.9%) used for rehydration for the DKA client?
A. Enters the cells rapidly
B. It contains glucose to correct hyperglycemia.
C. It is hypotonic and pulls water into the cells
D. It is isotonic and remains in the extracellular fluid to restore blood volume.
D. It is isotonic and remains in the extracellular fluid to restore blood volume.
What are the potential complications for HHS?
A. Chronic Kidney failure
B. Hypervolemia
C. Acute kidney injury
D. Electrolyte balance
Answer C: Acute kidney injury
Which of the following is a DKA Complication?
A. Wheezing
B. Metabolic alkalosis
C. Hyperglycemia
D. Cardiac arrhythmias
Answer: D Cardiac arrhythmias